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Pharmacotherapeutic Management of Wilms Tumor: An Update

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Abstract

Although differences exist in treatment and risk-stratification strategies for children with Wilms tumor (WT) between the European [International Society of Paediatric Oncology (SIOP)] and American [Children’s Oncology Group (COG)] study groups, outcomes are very similar, with an overall survival of > 85%. Future strategies aim to de-intensify treatment and reduce toxicity for children with a low risk of relapse and intensify treatment for children with high-risk disease. For metastatic WT, response of lung nodules to chemotherapy is used as a marker to modify treatment intensity. For recurrent WT, a unified approach based on the use of agents that were not used for primary therapy is being introduced. Irinotecan is being explored as a new strategy in both metastatic and relapsed WT. Introduction of biology-driven approaches to risk stratification and new drug treatments has been slower in WT than in some other childhood cancers. While several new biological pathways have been identified recently in WT, their individual rarity has hampered their translation into clinical utility. Identification of robust prognostic factors requires extensive international collaborative studies because of the low proportion who relapse or die. Molecular profiling studies are in progress that should ultimately improve both risk classification and signposting to more targeted therapies for the small group for whom current therapies fail. Accrual of patients with WT to early-phase trials has been low, and the efficacy of these new agents has so far been very disappointing. Better in vitro model systems to test mechanistic dependence are needed so available new agents can be more rationally prioritized for recruitment of children with WT to early-phase trials.

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Acknowledgements

The authors thank Suzanne Tugnait for her contribution to the final editing of the manuscript.

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  1. UCL Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK

    Radna Minou Oostveen & Kathy Pritchard-Jones

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RMO is funded by the Great Ormond Street Hospital Children’s Charity (grant reference W1090). KPJ is funded in part by the National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Children’s Charity, Cancer Research UK (grant no. C1188/A4614) and the Children’s Cancer and Leukaemia Group (Bethany’s Wish, grant reference CCLGA 2017 02).

Conflict of interest

Radna Minou Oostveen and Kathy Pritchard-Jones have no conflicts of interest that might be relevant to the contents of this manuscript.

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Oostveen, R.M., Pritchard-Jones, K. Pharmacotherapeutic Management of Wilms Tumor: An Update. Pediatr Drugs 21, 1–13 (2019). https://doi.org/10.1007/s40272-018-0323-z

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